Healthcare Provider Details

I. General information

NPI: 1881881902
Provider Name (Legal Business Name): NEW MEXICO COMMUNITY PSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 W 21ST ST
CLOVIS NM
88101-4026
US

IV. Provider business mailing address

1916 W 21ST ST
CLOVIS NM
88101-4026
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-2121
  • Fax: 575-935-2122
Mailing address:
  • Phone: 575-799-1412
  • Fax: 575-935-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2007-0653
License Number StateNM

VIII. Authorized Official

Name: DR. ANNE S ORTIZ
Title or Position: OWNER
Credential: M.D.
Phone: 575-799-1412